[Transoral coronoidectomy: Technical note]. / Coronoïdectomie intra-orale: note technique.

INTRODUCTION: Among the skeletal causes of limited mouth opening, uni- or bilateral coronoid process hypertrophy, or Langenbeck disease, is the most frequent. It can be associated with an osteochondroma or a coronoid-malar bone conflict and is then called Jacob disease, an unilateral pathology. Treatment rests on coronoidectomy in both cases. This technique is illustrated via two cases, one Langenbeck and one Jacob disease. TECHNICAL NOTE: A transoral approach was performed. After subperiosteal dissection, the coronoid process was cleared. The process was than severed at its base by means of a burr, freed from its temporal muscular fibers and removed. Mouth opening improved peroperatively. The surgical procedure was completed by active long-term physiotherapy beginning immediately after surgery. DISCUSSION: Transoral coronoidectomy is a simple, quick and safe procedure. Extra-oral approaches present a high risk of facial nerve injury. In our first case, mouth opening improved from 24 to 36 mm after bilateral coronoidectomy and to 40 mm after physiotherapy. In our second case, mouth opening improved from 22 to 38 mm after unilateral coronoidectomy and to 43 mm after one year physiotherapy. Long-term post-operative physiotherapy is mandatory to get and maintain good results.

[Comparison between Polyglactin 910 (Vicryl®) versus irradiated Polyglactin 910 (rapid Vicryl®) for mucosal suture after wisdom teeth avulsion]. / Comparaison Polyglactine 910 simple (Vicryl®) versus Polyglactine 910 irradié (Vicryl rapide®) en suture muqueuse après avulsion des dents de sagesse.

INTRODUCTION: Two different types of suture are used in our unit after wisdom tooth extraction, Polyglactin 910 [PGS] (Vicryl®, Ethicon) and rapid absorption irradiated Polyglactin 910 [PGI]. No objective comparative study was available so we decided to conduct a preliminary prospective study to check if there was any difference between these two types of suture. PATIENTS AND METHODS: Forty patients were included in our study, consecutively operated for impacted wisdom teeth by the same surgeons, between April and June 2010. The symmetry of impaction was systematically controlled on panoramic views before including a patient in the study. PGS and PGI were both used for every patient, PGS on one side and PGI on the other. The "right or left" PGS-PGI distribution was randomized and double-blinded. The patient was his own control. Thirty-two patients were examined at the postoperative consultation, during which an evaluation questionnaire was completed with the surgeon. Pain, difficulty to chew, duration of swelling, dysgeusia, and major complications (inflammation, disunion, infection) were analyzed. RESULTS: The statistical analysis revealed that postoperative pain was greater on the PGS side (VAS=3.7) than on the PGI side (VAS=2.8) without any significant difference. The duration of swelling was significantly higher on the PGS side (5.5days) than on the PGI side (3.1days). Coming back to normal food intake did not seem different; it was not interrupted. PGI also significantly reduced the difficulty to chew and dysgeusia. There was no difference in complications between PGS and PGI. DISCUSSION: This study proved the superiority of PGI over PGS during the three postoperative weeks after extraction of wisdom teeth, in terms of comfort and edema.

[Is orthognathic surgery an alternative for mandibular osteopetrosis?]. / Ostéopétrose mandibulaire: la chirurgie orthognatique est-elle possible ?

INTRODUCTION: Osteopetrosis is a metabolic bone disease that leads to bone malformation and bone healing disorders. We report the case of a patient who underwent orthognathic surgery to treat a class III skeletal malocclusion. OBSERVATION: A 21-year-old patient had presented with osteopetrosis in his childhood, which had been treated by bone marrow transplantation. He presented with esthetic and functional sequels, a class III skeletal malocclusion, lateral mandibular deviation, and dental agenesis. This dysmorphism was corrected by bimaxillar osteotomy. The postoperative outcome was uneventful, with satisfactory and stable healing. DISCUSSION: The patient's lesions where after-effects of his disease, but the bone structure is normal, because osteopetrosis regressed after bone marrow transplantation. There is no risk for the consolidation. Osteopetrosis, even when treated by bone marrow transplantation, is not a contraindication for maxillomandibular osteotomy.